Comparability and validity of siriraj stroke score and allen stroke score in differentiation of acute ischemic and haemorrhagic stroke

To compare and validate Alien stroke score [ASS] and Siriraj stroke scores [SSS] in differentiating acute cerebral hemorrhage [CH] and cerebral infarction [CI]. This comparative, analytical study was conducted at Khyber Teaching Hospital Peshawar, Pakistan from July 2000 to February 2002. Study included 100 patients of acute ishemic or hemorrhagic stroke confirmed on CT scan brain after clinically evaluation. ASS and SSS were calculated for each patient and compared with the results of CT scan for comparability [Kappa Statistics] and validity by using SPSS 10. Out of 100 patients, 69 had CI and 31 had CH. The overall comparability of ASS and SSS was fair [Kappa=0.51]. ASS and SSS were uncertain in 27 and 18 cases respectively; with Kappa showing worst comparability in term of certain results [K= 0.23]. In 64 cases with both scores in the diagnostic range, the Kappa showing excellent comparability [K=0.91].The sensitivity, specificity, positive predictive value [PPV] and negative predictive value [NPV] of ASS was 38.70%, 91.30%, 66.67%, 76.82% respectively for CH and 71.1%, 80.64%, 89.09% and 55.56% respectively for CI, with overall predictive accuracy of 61%. The sensitivity, specificity, PPV and NPV of SSS was 67.74%, 94.2%, 84% and 86.67% respectively for CH and 78.26%, 90.32%, 94.73% and 65.11% respectively for CI, with overall predictive accuracy of 75%. Although, SSS being simple with more accuracy is better than ASS, both these scores lack sufficient validity to be used for exclusion of cerebral haemorrhage before offering antithrombotic or thrombolytic therapy

Principal causes of coma in medical units of a tertiary care hospitals of Peshawar

To determine the principal causes of coma in patients admitted to the medical units of a tertiary care hospital of Peshawar. This cross sectional study was conducted at department of medicine, Khyber teaching hospital Peshawar, from July 2006 to August 2007. All patients were randomly selected. Relevant information's were recorded on a questionnaire prepared in accordance with the objectives of the study. A total of 124 patients with coma, 96[77.41%] males and 28[22.58%] females were included in the study. The age range of patients was from 12 years to 72 year with mean age of 50.5 years. The principal causes of coma were: cerebrovascular accident [CVA] 73.38% [n=91], epilepsy in 10.48% [n=13], injury head 5.64% [n=11], hepatic coma 2.41% [n=3], central nervous system [CNS] infections 2.41% [n=3], metabolic acidosis, drug abuse [1.61%] [n=2] each and cerebral malaria, hypoglycemia and uremia 0.8% [n=1] each. Risk factors for stroke recorded were hypertension in 46.2% [n=42/91], diabetes in 15.4% [n=14/91], ischemic heart disease 12.1% [n=11/91], smoking 5.5% [n=5/91], hyperlipedemia 3.3% [n=3/91] and atrial fibrillation 1.1% [n=1/91]. Scoring on Glasgow coma scale showed that 74.2% [n=92] patients scored 3-8, 25.8% [n=32] scored 9-12 and none of the patients scored 13-15. In our setup CVA is the most common cause of coma followed by epilepsy, and trauma head. Other minor causes recorded were metabolic acidosis, drug abuse, central nervous system infections, cerebral malaria, hypoglycemia and uremia

Principal causes of coma in medical units of a tertiary care hospital of Peshawar

To determine the principal causes of coma in patients admitted to the medical units of a tertiary care hospital of Peshawar. This cross sectional study was conducted at department of Medicine, Khyber Teaching Hospital Peshawar, from July 2006 to August 2007. All patients were randomly selected. Relevant information was recorded on a questionnaire prepared in accordance with the objectives of the study. A total of 124 patients with coma, 96[77.41%] males and 28[22.58%] females were included in the study. The age range of patients was from 12 years to 72 year with mean age of 50.5 years. The principal causes of coma were: cerebrovascular accident [CVA] 73.38% [n=91], epilepsy in 10.48% [n=13], head injury 5.64% [n=11], hepatic coma 2.41% [n=3], central nervous system [CNS] infections 2.41% [n=3], metabolic acidosis, drug abuse [1.61%] [n=2] each and cerebral malaria, hypoglycemia and uremia 0.8% [n=1] each. Risk factors for stroke recorded were hypertension in 46.2% [n=42/91], diabetes in 15.4% [n=14/91], ischemic heart disease 12.1% [n=11/91], smoking 5.5% [n=5/91], hyperlipedemia 3.3% [n=3/91] and atrial fibrillation 1.1% [n=1/91]. Scoring on Glasgow coma scale showed that 74.2% [n=92] patients scored 3-8, 25.8% [n=32] scored9-12 and none of the patients scored 13-15. In our setup CVA is the most common cause of coma followed by epilepsy, and head injury Other minor causes recorded were metabolic acidosis, drug abuse, central nervous system infections, cerebral malaria, hypoglycemia and uremia

Comparative analysis of risk factors and complications of hepatitis B and C infections at Khyber Teaching Hospital, Peshawar

To analyze comparatively the risk factors and complications of hepatitis B and C infections at Khyber Teaching Hospital, Peshawar. A cross-sectional observational study was conducted in Department of Medicine, Khyber Teaching Hospital, Peshawar, from March 2005 to October 2006. Relevant information's were obtained from the patients with the aid of a pre-designed questionnaire prepared in accordance with the objectives of the study. A total of 432 patients with positive anti-HCV antibody 252 [58.33%] and positive HBs Ag 180 [41.66%] were included. The age range of the patients with anti-HCV antibody was from 11 to 84 years with the mean age of 47.5 years, while in HBV cases was 50.5 years [range: 7 to 87 years]. In HCV positive cases, 165 [65.47%] were males and 87 [34.52%] were females while in HBV patients, 123 [68.33%] were males and 57 [31.67%] were females. The risk factors of HCV patients were: intravenous drug users, 23.81%; HCV positive sexual partners, 15.07%; blood or blood products transfusion, 13.49%; and occupational acquired-HCV, 7.14%. The major risk factors of HBV were: intravenous drug users, 33.88%; HBsAg positive sexual partners, 23.33%; blood transfusion, 14.44%; and dental procedures [tooth extraction or root canal treatment], 9.44%. Unknown source of infection was recorded in 25% of HCV and 10.56% of HBV patients. Complications consequences in HCV patients were: chronic hepatitis, 34.52%; liver cirrhosis, 16.26%; hepatocellular carcinoma, 0.79%; fulminant hepatitis, 0.79%; while 47.61% were asymptomatic or sub-clinical symptomatic. In HBV patients, complications were acute hepatitis, 5.56%; fulminant hepatitis, 0.5%; chronic healthy carriers, 31.67%; chronic hepatitis, 24.44%; liver cirrhosis, 6.11%; and hepatocellular carcinoma, 1.10%; while 40.55% were clinically asymptomatic or with sub-clinical disease. Coexistence of HCV and HBV were recorded in 52 [12.03%] patients. History of sexual transmission favors HBV infection while blood transfusion and occupational exposure were recorded mainly in HCV positive patients. Chronic persistent hepatitis and liver cirrhosis were recorded more significantly with HCV infection while HBV favor carrier state or presents as a sub-clinical disease

Upper gastrointestinal endoscopic assessment of patients presenting with dyspepsia

To evaluate common causes of dyspepsia and to correlate endoscopic findings with histological examination of biopsy specimens. Material and This observational descriptive study was conducted at department of medicine Khyber Teaching hospital Peshawar, from 1st June 2006 to 31st December 2006. Detailed history, thorough physical examination and relevant investigations were done in each patient. All patients underwent upper gastrointestinal [GI] endoscopy. Biopsies were taken in every patient from oesophagus, stomach and duodenum. Histological examination was done from single pathologist. The endoscopic findings of 50 patients with dyspepsia were studied. Out of 50 patients, 35[70%] were males while 15[30%] were females. Eighty two percent [41/50] were in the age group of 30-50 years. The most common presentations were epigastric pain in 45 [90%] cases, heartburn in 36 [72%] and flatulence in 35 [70%] cases. The endoscopic findings were normal in 25 [50%] patients. The abnormal findings included esophagitis in 6 [12%] patients, gastric ulcer in 5 [10%] patients, duodenal ulcer in 4 [8%] patients, gastritis in 4 [8%] patients and duodenitis in 2 [4%] patients; while esophagogastritis, gastroduodenitis, esophagogastroduodenitis and carcinoma stomach were present in 1 [2%] patient each. All the endoscopically abnormal as well as normal findings were confirmed by histopathology. The endoscopic findings were normal in majority of patients with dyspepsia. The common abnormal endoscopic findings included esophagitis, gastric ulcer, duodenal ulcer and gastritis. The endoscopic findings were, matching with histological diagnosis

Ischemic stroke: risk factors and disturbance of consciousness [a hospital-based study]

This prospective observational study was conducted to determine the risk factors and disturbance of consciousness level in stroke patients in the medical wards of Khyber Teaching Hospital, Peshawar, Pakistan, from June 2005 to August 2006. A questionnaire was prepared in accordance with the objectives of the study. The questionnaire contained detailed history, general physical examination, and neurological examination. Prognosis of the disease was studied with the help of Glasgow Coma Scale [GCS] [severity of unconsciousness] scoring system. One-hundred and eighty-three patients with established diagnosis of stroke were selected. Forty-seven [25.68%] had more than one risk factor. The age range of the patients was 31-92 years with mean age of 57 years. Out of total, 111 [60.65%] were male and 72 [39.34%] were female. The distribution of risk factors was as follows: hypertension 95 [51.91%], diabetes 56 [30.60%], hyperlipidemia 21 [11.47%], smoking 23 [12.56%], ischemic heart diseases 21[11.47%], atrial fibrillation 5 [2.73%], obesity 5 [2.73%], physical inactivity 2 [1.09%], history of heparin or warfarin use 2 [1.09%], and history of oral contraceptive use 1 [0.54%]. The prognosis of the disease based on the GCS scoring system [severity of unconsciousness] was studied only in 122 [66.66%] patients. Out of 122 patients, 42.62% had scores greater than ten, 35.24% between 6 and 10, and 22.13% less than five. Hypertension, diabetes, hyperlipidemia and smoking are major modifiable risk factors of stroke in our patients. More than half of the patients had unsatisfactory GCS scores, which indicates poorer prognosis

Hypertension in acute ischemic and haemorrhagic stroke

To know the pattern of systolic and diastolic blood pressure in hypertensive patients with acute ischemic and hemorrhagic stroke. Material and This study was conducted on 100 patients with acute stroke, admitted in Khyber Teaching Hospital from July 2000 onward. Hypertensive patients were finally selected for analysis. BP was recorded at arrival and 24 hours after admission. Out of 100 patients with stroke, hypertension was present in 72 cases. Out of these 72 patients, 44 cases [61.1%] had cerebral infarction [CI] and 28 cases [38.9%] had cerebral haemorrhage [CH]. Overall mean systolic BP at arrival [SBP-A] was 163 [ +/- 35.606] mm Hg. Mean SBP-A in patients with CI was 152.3 [ +/- 34.397] mm Hg and in patients with CH was 181.25 [ +/- 30.357] mm Hg. Overall 68% of hypertensive stroke patients had uncontrolled systolic BP at arrival. Overall mean diastolic BP at arrival [DBP-A] was 95. 97 [ +/- 20.733] mm Hg. Mean DBP-A in CI was 88.75[ +/- 17.854] mm Hg and in CH was 107.32[ +/- 20.115] mm Hg. The mean difference of DBP-A in CH and CI was 18.57mm Hg. Mean systolic BP and Mean diastolic BP, 24 hours after admission were 157.85 mm Hg and 92.08 mm Hg respectively. Majority of hypertensive stroke patients have uncontrolled blood pressure. Hypertension is a risk factor for both ischemic and hemorrhagic stroke. More elevation of blood pressure is more frequently associated with cerebral hemorrhage than cerebral infarction

Late onset asthma and pulmonary infiltrates

We are discussing a patient who was initially diagnosed and treated as pulmonary tuberculosis, but on follow up the clinical, radiological features and investigations were highly suggestive of pulmonary vasculitis. Pulmonary vasculitis occurs in a number of conditions including polyarteritis nodosa, SLE, and Wegener's granulomatosis. This can be the sole manifestation of these diseases for months to years before other systemic manifestations appear